Notification of Changes for Business Entity
General Information
Business Entity Name:	AB RISK SPECIALIST, INC.
Incorporation / Formation Date:	05/04/2009
FEIN:	264793693
Ohio License Number:	934148 AND 42243
NPN:	14123907
DBA / Trade Name:
State of Domicile:	GA
County:	GWINNETT
Business Address
Address 1:	931 TULLIS ROAD
Address 2:
City:	LAWRENCEVILLE
State:	GA
Zip:	30043
Phone:	770-339-3559
Fax:
Business Web Site Address:	HTTP://WWW.ABRISK.COM
Business Email Address:	LAURAMANTLER@ABRISK.COM
Mailing Address
Address 1:	931 TULLIS ROAD
Address 2:
City:	LAWRENCEVILLE
State:	GA
Zip:	30043
Indicate the type of change you are seeking
Address Change:	NO
Business Entity Name Change:	YES	Old Business Entity Name:	AB RISK SPECIALIST, INC.
New DBA/Trade Name:	NO	New DBA/Trade Name:	AB RISK SPECIALIST, LLC
Amend DBA/Trade Name:	NO	Old DBA/Trade Name:
Add/Delete Producers, Members, Owners, Partners, Officers and/or Directors:	NO

Licensed Producers
Name	Title	NPN	Add	Delete	Eff. Date

Members, Owners, Partners, Officers and Directors
Name	Title	Identifying #	Add	Delete	Eff. Date

Title Business Entities Only
1. Is any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance? (i.e. banking, auto dealer, mortgage company)
2. Has any member, producer, owner, share holder, manager, partner, officer or director currently engaged in deriving income from or affiliated with (other than as a customer) any business or profession other than insurance since the filing of the previous CN-65 or the original application?
3. If the answer to questions #1 or #2 is yes, identify the business or profession and the nature of person's involvement

Submitted By
Submitted By:	LAURA MANTLER
Title:	COMPLIANCE ADMINISTRATOR
Phone Number:	410-870-2904
Email Address:	LAURAMANTLER@ABRISK.COM